Coaching Packet

 

                                                         

                                                                    PERSONAL INFORMATION

Professional Coaching includes an initial extended evaluation, weekly telephone sessions, and perhaps e-mail, telephone and fax communication.  In-person meetings are also available.

 

Date: ________________ Referred by: __________________________________________

 

Name: ____________________________________ DOB: ________________ Age: ______

 

Home Address: ____________________________________________________________

 

___________________________________________________________________

 

Occupation: ________________________________________________________________________

 

Business Name and Address: ________________________________________________________________________

 

________________________________________________________________________

Home phone: ______________________________ Business Phone: ___________________          Fax line: __________________________________ E-Mail:_________________________        Can LLT Life Coaching leave a message:   Yes __    No __

Preferred means of communication:   Phone __    Email __    Other: _______________________           Names of important people in your life (spouse, partner, children, friends, etc.): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

Other information you want me to know: ________________________________________________________________________ ________________________________________________________________________

 

ABOUT YOU

 

1.  I want to improve or expand/extend use of the following skills or develop and create the following

components to my professional/personal life:

a)

b)

c)

 

2.  I want to resolve the following challenges or problems:

a)

b)

c)

 

3.  I want to eliminate the following tolerations (what I’m putting up with in my life/business now):

a)

b)

c)

 

4.  I want to accomplish the following measurable or observable results:

a)

b)

c)

 

5.  At this point, I think that I’d like to make these fundamental changes or shifts:

a)

b)

c)

 

6.  What I want and need most from you, as my coach, includes:

a)

b)

c)

 

7.  Also, I want you to know that:

a)

b)

c)

 

PROFESSIONAL COACHING AGREEMENT

 

 

I understand that I am working with Emra Smith for professional coaching at the agreed fee.  I am paying this monthly retainer by check or Pay Pal prior to the beginning of the month.  We will have standing scheduled times each week by telephone or meeting in person, as deemed most useful. Additionally, we may have other interim though limited exchanges by telephone, email, or for review of faxed material without additional charge. If there are special circumstances or events that require significant time or an additional session, we can renegotiate rates.

 

 

All information will be held as confidential unless the client requests otherwise in writing.

 

 

Professional Coaching is distinctly different than counseling, psychotherapy, and psychoanalysis, and does not deal with the diagnosis or treatment of emotional problems. Since Professional Coaching does not constitute medical consultation or treatment, any healthcare insurance does not apply. These fees may be considered deductible business expenses.

 

 

 

 

 

Signature: _______________________           Date: ___________________

 

 

 

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